P010 - ADHERENCE TO INFLIXIMAB FOR INFLAMMATORY BOWEL DISEASE, A MULTICENTER RETROSPECTIVE REVIEW
(Room Poster Hall)
19 Jan 18
5:30 PM
-
7:00 PM
Tracks:
Clinical and Research Challenges
Background: Non-adherence to Infliximab (IFX) is associated with an increased risk of anti-drug antibodies which can lead to loss or response. We performed a retrospective review of IFX use among Veterans with inflammatory bowel disease (IBD) with the aim of quantifying adherence and assessing the relationship between adherence and outcomes such as persistence on IFX, dose escalation, and hospitalizations. Methods: The Veteran’s Health Administration (VHA) electronic medical records of 4 institutions were reviewed to identify patients newly initiated on IFX for IBD between 2000-2017. Patients were excluded if they received <4 infusions or if they were on IFX prior to receiving care in the VHA system. Adherence to IFX was assessed as receiving ≥7 infusions within 1st year and ≤7 day cumulative delay during induction infusions. Descriptive statistics were calculated using SAS 9.4. Results: During the study period, 95 patients were initiated on IFX in the VA who met our inclusion criteria. Of these patients, 78 (82.1%) had a diagnosis of Crohn’s disease with a mean age of 45.3 years (± 10.9) and 88.4% were male. Over 9 infusions, 47 (49.5%) were escalated. Of the 95, 76 underwent ≥7 infusions and of these 87.4% were adherent as defined by 7 infusions within 1 year. A delay during induction was common (23.2%). Patients with delays during induction were more likely to stop the drug before 9 infusions (40.9% vs 16.4%, p=0.02) and more likely to undergo escalation (72.7% vs. 42.5%, p=0.01). There was no difference in hospitalization rates between those who were adherent or not adherent. No predictors of delays during induction could be identified. Conclusions: While adherence to IFX using the definition of 7 infusions in 1 year was high, 23.2% had significant delays during induction. Since patients who missed days during induction were less likely to persist and more likely to be escalated, more attention should be focused on adherence during this critical time period.